This is a fluoroscopy detection device designed to enable more dose efficient fluoroscopy examinations by extending quantum limited x-ray photon detection to below 1 uR per frame. This is directly applicable to all fluoroscopy. Existing "flat panel" x-ray imagers have a dose dependent DQE, such that image quality deteriorates badly at low radiation photon counts, which are still adequate in an x-ray statistical sense to provide clinically useful images. The system approaches "photon counting" methods in sensitivity to x-radiation. It is a conventional x-ray geometry, with an improved detector based on a newly discovered and patented CCD method of operation with an on-chip gain register. The gain register obviates output amplifier noise problems at room temperature which previously limited all prior systems of this generic type. If implemented, the possibility to reduce all fluoroscopy examination low end dose rates by 50 percent or more exists, due to more efficient registering of sparse photon counts. The target application is interventional radiology and cardiac cath labs. The goal is to build a lab model in Phase I and then a clinical device in Phase II. No overheads are charged to the grant, only direct expenses, and a small fee to help cover the cost of space used. The operating premise has been modeled virtually (enclosed as an Appendix to Phase II) and is 100 percent positive.